NATIONAL
PANEL SOUNDS ALARM ABOUT LACK OF PHYSICIAN TRAINING TO TREAT CHRONIC
PAIN; MAJOR HEALTH GROUPS ENDORSE NEW REPORT WHICH
CALLS FOR URGENT MEDICAL SCHOOL AND HEALTH SYSTEM REFORM

“Epidemic”
of under-treatment affects more than 70 million Americans suffering from
persistent back pain, headaches, joint pain; disproportionately
affects minorities and low income

WASHINGTON, DC (November 4,
2009)-- Warning that patients shouldn’t assume their doctor has enough
knowledge to treat their pain, a national panel of experts today called
on medical schools to train doctors and nurses on the basics of pain
care, reform the nation’s reimbursement system, and address pain as
a public health crisis. The group insists that without health reforms
and better training to diagnose and treat pain properly, people with
untreated pain may face a lifetime of pain as a chronic illness –
which could lead to job loss, depression and in some cases, even suicide.

“Doctors, who don’t lack
for compassion or medical skills, often offer only limited treatments
to patients disabled by chronic pain,” said Lonnie Zeltzer, M.D.,
co-chair of the panel, and the director of the Pediatric Pain Program
at the University of California, Los Angeles. “With little or
no specific training in pain management, and working in systems that
make it much easier to treat common conditions like high blood pressure
than a complex problem like pain, doctors may intend to help but leave
most patients under-assessed and under-treated. Minorities, children
and women often faced the highest risk of under-treatment.”

The panel, convened by the
New York City-based Mayday Fund, included anesthesiologists, neurologists,
primary care doctors, pediatricians, emergency physicians, nurses, psychologists,
pharmacists and patient advocates (the full Committee
is included below).
After a conference in Washington D.C. and deliberations that lasted
over several months, the panel’s report, A Call to Revolutionize
Chronic Pain Care in America: An Opportunity in Health Care Reform,
says pain is a huge public health problem. They developed several recommendations
for government agencies, Congress and the medical community to address.

The report and recommendations
have been endorsed by more than 30 organizations, including the American
Academy of Family Physicians, American Academy of Pediatrics, The Joint
Commission, American Nurses Association, American College of Emergency
Physicians, and the American Academy of Neurology (the list of current
signatories is below).

“As we get closer to the
possibility of health care reform, the frontlines of medicine - adult
and pediatric primary care - could face enormous strains from millions
of new patients seeking care for pain,” says Russell K. Portenoy,
M.D., panel co-chair and the chairman of Pain Medicine and Palliative
Care at the Beth Israel Medical Center in New York. “Primary
care is the first stop for people in pain, and both the training received
by clinicians and the system of care should facilitate best practices
in pain care, but this is not the way it is.”

The Mayday Fund Special
Committee on Pain and the Practice of Medicine writes that chronic
pain should be reframed as a chronic illness since “the burden of
chronic pain is greater than that of diabetes, heart disease and cancer
combined.” People in chronic pain have longer hospital stays, and
many duplicative tests and unproven treatments—all of which drive
up the nation’s health care spending, the panel said.

Chronic pain costs the nation
more than $100 billion a year in lost productivity and direct medical
costs, the report says. “This is a wasteful system,” Portenoy adds.
“Major reforms in the health care system are needed if we want to
improve the quality and cost effectiveness of care for chronic illnesses,
and pain is as much a chronic illness as diabetes and heart disease.”
Although the impact of pain on patients and on society is among the
most serious of public health concerns, chronic pain has been largely
left out of the current national debate on health reform, the panel
writes.

According to the report, about
“one-third of people in pain report that their pain is disabling and
has a high impact on their ability to function in daily life.
Research suggests that the high cost of under-treated pain includes
lost productivity. Pain is the second-leading cause of medically-related
work absenteeism, resulting in more than 50 million lost workdays.”

The authors pay particular
attention to the numerous studies that suggest low-income populations,
minorities, women and children are more likely to be under-treated for
pain or not receive pain care at all. If doctors do not recognize
chronic pain as a serious illness, or as serious as others, or they
perceive that pain complaints cannot, or should not, be treated, persistent
pain results. In some cases, such as pain in young children and
adults with dementia, patients may not report their pain, and under-assessment
drives under-treatment.

“The tragedy of this system
is that it leaves many people suffering from unrelenting pain,” says
Zeltzer. “Pain that goes untreated may permanently change the body’s
nervous system and may lead to pain that can be managed but never goes
away.”

Federal policymakers have recognized
the impact pain has on individuals and the health care system and have
included provisions of the National Pain Care Policy Act 2009 (NPCPA)
in health reform proposals. That bill calls for an Institute of
Medicine Conference on Pain; increased funding for the National Institutes
of Health to collaborate across institutes to find more effective treatments
for pain and to better understand the biology of pain; a grant program
to improve health professionals’ understanding of and ability
to assess and treat pain; and better public education so that consumers
understand the danger of letting pain go untreated.

“Remarkably, less than one
percent of the NIH budget was devoted to pain in 2008,” Zeltzer said.
“This amount is not commensurate with a public health problem of this
magnitude.”

In addition to medical school
reforms and expanded funding for pain management training programs,
the panel cited specific measures that would ease this public health
crisis. Among them:

Health care providers,
insurers and government agencies should eliminate disparities in access
to pain care related to race, gender, age and socioeconomic status.
All Americans in pain, including low-income Americans, should be offered
timely and effective treatment for their pain.

Government, health
care payors and providers should develop coordinated health information
technology (IT) systems to track pain disorders and treatments. Computerized
IT systems can boost physicians’ knowledge about the best treatment
for pain by providing them with best practice information quickly.

The Department of
Health and Human Services should reform payment to eliminate the current
incentives that drive pain care toward procedures or unproven treatments.
Primary care doctors should be reimbursed for the time it takes to provide
comprehensive pain care to patients who are disabled by chronic pain—a
system that can cost a little more up front, but often reduces the cost
of treating pain over the long haul.

The Surgeon General
should mount a public education campaign to inform the public about
the risks associated with under-treated pain. Consumers should understand
that if they wait too long to treat acute pain they run the risk of
developing a chronic syndrome, one that’s costly to treat and potentially
disabling.

“Reducing the burden of uncontrolled
chronic pain is a societal necessity, a medical challenge and an economic
requirement,” the panel says.

The Mayday Fund is a New
York City-based private philanthropy dedicated to alleviating the incidence,
degree and consequences of human physical pain.
The Mayday Fund does not lobby or retain individuals or organizations
to lobby. The panel participants are listed below. To obtain
a copy of the report please visit www.MaydayPainReport.org.

THE MAYDAY
FUND SPECIAL COMMITTEE ON PAIN
AND THE PRACTICE OF MEDICINE

Rollin M. Gallagher, MD,
MPHPresident, American Academy
of Pain MedicineClinical Professor of Psychiatry
& Anesthesiology, Director for Pain Policy Research & Primary
Care, University of Pennsylvania
School of Medicine

Carmen R. Green, MDProfessor of Anesthesiology
and Obstetrics & Gynecology, University of Michigan School of MedicineAssociate Professor of Health
Management & Policy, University of Michigan School of Public Health